ARTISAN CONTRACTOR INSURANCE QUOTE REQUEST
Complete the following information if you would
like to obtain an Artisan Contractor Insurance quote. Please
understand this is not an application. An application will be
sent to you if coverage is desired.
All information provided on this information
sheet is confidential and will be used solely for the purpose
of developing a quote for you.
Personal Information
What is your name?
Last
First
Middle
What is your business name?
Business Name
What is your address?
Street
City
State
Select
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Washington DC
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip
What is your telephone number?
Home
Business
What is your fax number?
Fax
What is your email address?
Email
Underwriting Information
How many owners?
Number of Owners
How many employees?
Number of Employees
What is the payroll amount of the owners?
Payroll of Owners
What is the payroll amount of the employees?
Payroll of Employees
What is the total annual gross?
Total Annual Gross Receipts
What are the annual sub costs?
Total Annual Sub Costs
What is your classification?
Classification
Select
Air Conditioning-Dwelling
Air Cooled
Engine Repair
Appliance
Repair Coml (No LPG)
Appliance Repair-Dwelling
Cable TV Installation
Carpentry - Interior
Carpentry - Other
Carpentry - Dwelling
Carpentry - Shop
Carpet
Rug Upholstery Cleaning
Ceiling
or Wall Installation
Chimney Cleaning
Steam
Cleaning - High Pressure
Communication
Equip Installation
Concrete Construction
Contractors
- Permanent Yard
Small Debris Removal
Door
& Window Installation
Driveway Paving
Drywall Installation
Electrical
Apparatus Installation
Electrical
Work In Building
Excavation - Minor
Fence Erection
Fire Extinguisher
Repair
Fire
Suppression System Repair
Floor
Covering Installation - No Tile
Floor Waxing
Furniture
- Fixture Installation
Garbage Collection
Grading of Land
Heating
& Air Conditioning
House
Furnishing Installation
Janitorial Service
Landscape - Gardening
Masonry
Metal Erection
- Decorative
Metal
Erection - Dwelling Const
Metal
Erection - Frame Structural
Metal
Erection - Non Structural
Metal Erection
- Structural
Office Machine
Repair
Painting - Exterior
Painting - Interior
Paper Hanging
Plastering - Stucco
Plumbing - Commercial
Plumbing - Dwelling
Prefabricated
Building Erectors
Roofer
- Dwelling (No Hot Tar)
Septic Tank Cleaning
Septic Tank Repair
Sewer Cleaning
Sheet Metal
Work - Outside
Siding
Installation - Repair
Sign Painting
- Inside
Solar Energy -
Repair
Street Cleaning
Sub Contractor
- Commercial
Sub Contractor
- Dwelling
Swimming
Pool - Below Ground
Swimming
Pool - Above Ground
Telephone
Cable TV Construction
Television - Repair
Tile,
Stone Mosaic - Installation
Tree Pruning
& Trimming
Truckers -
Non Hazardous
Upholstering -
Repair
Upholstering
- Shop Only
Water Softening
Equipment
Waterproofing
Waterproofing
- By Pressure
Waterproofing
- By Trowel Exterior
Window
Cleaning - Under 3 Stories
What is your contractors license number?
Contractors License Number
What is the license type?
License Type
Years of experience in this business?
Years of Experience
How many years have you operated under your
current business name?
Years Operated Under Current Name
Have you used any other business names during
the past 5 years?
Other Business Names
Yes
No
Have you been involved in the original construction
or remodeling of town homes, condos, row homes or developments of
15 or more unattached single family dwellings during the past 5
years?
Construction or Remodeling
Yes
No
Do you construct footings or foundations which
may support dwellings or other structures?
Construct Foundations
Yes
No
Do you construct slab or monolithic floors?
Construct Floors
Yes
No
Do you construct piers or underpinning which
may support dwellings or other structures?
Construct Piers
Yes
No
Do you construct retaining walls which may support
dwellings or other structures?
Retaining Walls
Do you construct fireplaces or chimneys?
Fireplaces or Chimneys
What is the percentage of work done as a General
Contractor?
Percentage as General Contractor
What is the percentage of work done as a Sub-Contractor?
Percentage as Sub-Contractor
What is the percentage of work done on Residential?
Percentage on Residential
What is the percentage of work done on Commercial?
Percentage on Commercial
What is the percentage of work done for Remodeling?
Percentage on Remodeling
What is the percentage of work done for Renovation?
Percentage for Renovation
What is the percentage of work done for Repair
or Maintenance?
Percentage for Repair or Maintenance
Claims Information
Where there any losses or claims in the last
5 years?
Losses - Claims
Yes
No
If yes, what is the date, amount paid and description
of each loss or claim?
Coverage Information
What is the current insurance company?
Select
20th Century
21st Century Casualty
AAA
AEGIS
AETNA
A G Edwards
AIG
Alliance
Allied
Allstate
American Family Insurance
American Manufacturers
Mutual
American National General
Amica Mutual
Blue Cross
Calfarm
Charter Insurance
CIGNA
Civil Service Employees
Clarendon National
CNA
Colonial Penn
Company Not Listed
Continental
Country Companies
Dairyland
Don't know name
Electric
Farm Bureau Insurance
Farmers
Farmers Union
Fidelity Guaranty
Fireman's Fund
First General
GEICO Casualty Co.
General Accident
Grange Ins Assn
Guaranty National
Hanover
Hartford
Horace Mann
John Hancock
Kemper
Liberty Mutual
Lumbermans Mutual
Metropolitan Insurance
Midwest Security
Millers Mutual Fire
Mutual of Omaha
Mutual of New York
National Farm Bureau
National General
Nationwide
New York Life
Northwestern Pacific
Pennsylvania General
Progressive
Providian
Prudential
Rural Insurance
SAFECO
Sentry
Shelter
State Farm
Travelers
Unigard
USAA
Viking
Workmens
Company Not Listed
Don't know name
How much are you paying now?
Amount Current Coverage
What is the liability limit requested?
Liability Limit
Select
$100,000
$300,000
$500,000
$1,000,000
What is the loss of income requested?
Loss of Income Coverage
Are there any questions, comments or additional
coverage required?
Questions, Comments or Additional Coverage